ICD-10 Coding for Right Shoulder Labral Tear(S43.431A, S43.431D, S43.431S)
Complete ICD-10-CM coding and documentation guide for Right Shoulder Labral Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Shoulder Labral Tear
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S43.431A | Sprain of superior glenoid labrum lesion of right shoulder, initial encounter | Use for initial encounter when active treatment is provided for a traumatic tear. |
|
| S43.431D | Sprain of superior glenoid labrum lesion of right shoulder, subsequent encounter | Use for subsequent encounters such as follow-up visits or physical therapy. |
|
| S43.431S | Sprain of superior glenoid labrum lesion of right shoulder, sequela | Use for long-term complications or symptoms resulting from the original injury. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for right shoulder labral tear
Essential facts and insights about Right Shoulder Labral Tear
Primary ICD-10-CM Codes for right shoulder labral tear
Decision Criteria
clinical Criteria
- Acute traumatic event leading to labral tear
documentation Criteria
- MRI findings confirming superior labral tear
Applicable To
- Acute traumatic tear of right shoulder labrum
Excludes
- Degenerative labral tears (M75.81)
Clinical Validation Requirements
- MRI confirmation of superior labral tear
- Positive O’Brien’s test
Code-Specific Risks
- Incorrectly using for degenerative tears
Coding Notes
- Ensure documentation specifies traumatic onset and active treatment.
S43.431D - Sprain of superior glenoid labrum lesion of right shoulder, subsequent encounter
Use for subsequent encounters such as follow-up visits or physical therapy.
Applicable To
- Follow-up care post-surgery
Clinical Validation Requirements
- Documentation of follow-up care or rehabilitation
Coding Notes
Ensure documentation reflects ongoing care or rehabilitation.
S43.431S - Sprain of superior glenoid labrum lesion of right shoulder, sequela
Use for long-term complications or symptoms resulting from the original injury.
Applicable To
- Chronic instability or pain post-injury
Clinical Validation Requirements
- Documentation linking current symptoms to past tear
Coding Notes
Link current symptoms to original injury in documentation.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Other shoulder lesions
M75.81Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Right Shoulder Labral Tear to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S43.431A.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to lack of specificity.
Mitigation Strategy
Ensure detailed documentation of injury mechanism and clinical findings.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on injury prevalence and treatment.
Mitigation Strategy
Use M75.81 for degenerative tears without acute trauma.
Impact
Using the wrong 7th character can lead to incorrect billing and audits.
Mitigation Strategy
Educate staff on proper use of 7th characters for encounter types.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Right Shoulder Labral Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Shoulder Labral Tear
Use these documentation templates to ensure complete and accurate documentation for Right Shoulder Labral Tear. These templates include all required elements for proper coding and billing.
Orthopedic Surgery H&P
Specialty: OrthopedicsRequired Elements
- Subjective: Patient history and symptoms
- Objective: Physical exam findings
- Imaging: MRI results
- Plan: Treatment strategy
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Right Shoulder Labral Tear? Ask your questions below.